Overdose cholinergic

The acronym SLUDGE, which stands for salivation, lacrimation, urinary incontinence, diarrhea, gastrointestinal disorders, and emesis, is often used to describe the systemic side effects of cholinergic overdose. A miotic upper respiratory syndrome consisting of rhinorrhea, a sensation of chest constriction, cough, and conjimctival injection has also been reported. 

Tricyclic antidepressants (TCAs) are effective for all depressive subtypes, but their use has diminished because of the availability of equally effective therapies that are safer on overdose and better tolerated. In addition to inhibiting the reuptake of NE and 5-HT, they also block adrenergic, cholinergic, and histaminergic receptors. 

The pronounced weakness that may result from inadequate therapy of myasthenia gravis (myasthenic crisis) can be distinguished from that due to anticholinesterase overdose (cholinergic crisis) by the use of edrophonium. In cholinergic crisis, edrophonium will briefly cause a further weakening of muscles, whereas improvement in muscle strength is seen in the... 

Overdose may result in cholinergic crisis, characterized by severe nausea, increased salivation, diaphoresis, bradycardia, hypotension, flushed skin, abdominal pain, respiratory depression, seizures, and cardiorespiratory collapse, increasing muscle weakness may result in death if respiratory muscles are involved. The antidote is 1 -2 mg IV atropine sulfate with subsequent doses based on therapeutic response. 

Since symptoms of anticholinesterase overdose (cholinergic crisis) may mimic underdosage (myasthenic weakness), their condition may be worsened by the use of this drug... 

Overdose may cause cholinergic crisis, characterized by increased salivation, lacri-mation, severe nausea and vomiting, bradycardia, respiratory depression, hypotension, and increased muscle weakness. Treatment usually consists of supportive measures and an anf icholinergic such as afropine. 

Overdose produces a cholinergic crisis manifested as abdominal discomfort or cramps, nausea, vomiting, diarrhea, flushing, facial warmth, excessive salivation, diaphoresis, lacrimation, pallor, bradycardia or tachycardia, hypotension, bron-chospasm, urinary urgency, blurred vision, miosis, and fasciculation (involuntary muscular contractions visible under the skin). 

Overdose may result in cholinergic crisis, characterized by severe nausea and vomiting, increased salivation, diaphoresis, bradycardia, hypotension, respiratory depression, and seizures. 

A cholinergic crisis should be treated by withdrawing all anticholinesterase medication, mechanical ventilation if required, and atropine i.v. for muscarinic effects of the overdose. The neuromuscular block is a nicotinic effect and will be unchanged by atropine. A resistant myasthenic crisis may be treated by withdrawal of drugs and mechanical ventilation for a few days. Plasmapheresis or immimoglobulin i.v. may be beneficial by removing antireceptor antibodies (see above). 

One herb, the calabar bea, actually causes cholinergic toxicity (as seen with pesticide overdoses) due to the physostigmine content in the ripe seeds. This toxicity includes bradycardia and hypotension, potentially leading to cardiac and respiratory arrest. ... 

Tacrine can cause mild hepatotoxicity, which is selfresolving on discontinuation. Other side effects, including those related to cholinergic effects, are nausea, emesis, diarrhea, abdominal pain, dyspepsia, rhinitis, myalgia, tremors, and excessive urination. Overdose symptoms include seizures, muscle weakness, low blood pressure, severe nausea, vomiting, fast and weak pulse, irregular breathing, and slow heartbeat. 

Monitor of the possibility of cholinergic crisis (overdose) symptoms include muscular weakness and increased salivation. 

Side effects/ adverse reactions Frequent Nausea, vomiting, diarrhea, anorexia Occasional Abdominal pain, insomnia, depression, headache, dizziness, fatigue, rhinitis Rare Tremors, constipation, confusion, cough, anxiety, urinary incontinence Adverse/toxic Overdose can cause cholinergic crises (increased salivation, lacrimation, urination, defecation, bradycardia, hypotension, increased muscle weakness). Treatment aimed at general supportive measures, use of anticholinergics (e.g., atropine)... 

Physostigmine competitively blocks acetylcholine hydrolysis by cholinesterase, resulting in acetylcholine accumulation at cholinergic synapses that antagonizes the muscarinic effects of overdose with antidepressants and anticholinergics. With ophthalmic use, miosis and cihary-muscle contraction increases aqueous humor outflow and decreases lOP. 

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